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Rehab Conflict of Interests

Discussion in 'Physical Therapy' started by atstudent, Aug 6, 2011.

  1. atstudent

    atstudent Certified Athletic Traine
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    HR 2785 has been introduced in the US House of Representatives. This law is also known as the Athletic Trainers Equal Access to Medicare Act and would allow athletic trainers to be a "qualified provider" to rehabilitate Medicare beneficiaries.

    I have my own thoughts on this idea; some pro and some con. But that's not necessarily where I'd like to see this topic head.. we've been down that road and is it really worth that fight again here?

    My question more revolves around your thoughts on physicians so-called "self-referral" and physical therapists "direct access."

    I have read many physical therapists are against athletic trainers being considered qualified because they say it's a conflict of interest for an MD to "self-refer" for rehab. But then at the same time, many physical therapists are calling for them to have direct access. I'd like to hear your thoughts on how they are different..
     
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  3. Fiveoboy11

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    I have no problem with athletic trainer's being reimbursed for their services, as long as it is athletic training, as agreed upon by other healthcare providers. In other words, if athletic trainer's are pushing to get into SNF's for rehabilitation as a physical therapist performs, then I am against it. Or if they want to rehab post-op MSK, then I am against that. I have no problem with them being reimbursed and hired to treat non surgical and minor sports/athletic injuries with autonomy. At the same time it would be difficult to discern what issues are "minor" so in comes the conflict of interest. Should a PT or physician decide this? I don't know.

    Direct access to physical therapy is no more a conflict of interest then any other healthcare provider with direct access. It has been proven that physician self referral to physical therapy has conflict of interest. So, if athletic trainers are reimbursed for their services. It should also be illegal for physician's to own athletic training facilities.
     
    #2 Fiveoboy11, Aug 6, 2011
    Last edited: Aug 6, 2011
  4. atstudent

    atstudent Certified Athletic Traine
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    I can't disagree with your last statement. But my question is if you as the physical therapist have direct access and you decide the patient needs rehab, how is that not "self-referral?" But if a physician sends a patient to rehab with either an athletic trainer or a PT and "self-refers" it is a conflict of interest? That's my big sticking point and maybe I'm missing something simple..
     
  5. jesspt

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    If you say the above example is self-referral, then all point of contact providers have self-referral.
     
  6. johncronejr

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    Exactly :thumbup:
     
  7. fozzy40

    fozzy40 Senior Member
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    When we say physician referral for physical therapy is a conflict of interest, are we saying all referrals or just if they are physician owned physical therapy services?
     
  8. johncronejr

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    A physician referring to a PT clinic that he owns is a conflict of interest.

    The way I see it, just because a physician owns a PT clinic does not mean he will abuse the arrangement, but it's easy to see how it could be abused and I am sure many would.
     
  9. Fiveoboy11

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    I'm not going to say I disagree with you on postop surgeries as you mention. Because I don't know the training an athletic trainer goes through for such things. Are you trained to rehab an acutely repaired ACL/rotator cuff? Or are you trained to rehab it after the patient has gone through rehab to a point and is then appropriate for "athletic training?"

    Also, we are talking within the context of medicare reimbursement. So, are athletic trainer's specialized enough to treat surgically repaired MSK issues in the elderly population, athletic or not? Again, I don't know.
     
  10. atstudent

    atstudent Certified Athletic Traine
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    I personally would say that if we are talking a strictly orthopedic injury, yes we could most likely do it. I have no interest in doing so myself. But I think it's important to note that while it is "Athletic Trainers' Equal Access to Medicare Act" the point isn't to necessarily be reimbursed through Medicare. The Centers for Medicare and Medicaid (CMS) ruled in 2004 that athletic trainers were not qualified to treat their beneficiaries. Many private insurances base their decisions on what the CMS says. So if the CMS would say we could be reimbursed through them, then it is more likely those other insurances would allow us to be reimbursed through them. Also, there are plenty of Medicaid patients who would fall into our "athletic population."
     
  11. fozzy40

    fozzy40 Senior Member
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    atstudent,

    Can you point me to a website that has an example of an ATC curriculum? I'm sure curriculum is institution dependent to an extent but I'm sure you would be able to recognize something that is representative.

    Thanks!
     
  12. jesspt

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    I think this is a misrepresentation of the typical physical therapist's opinion on the matter. I think that PTs will tell you that they do not feel that an athletic trainer is qualified to provide physical therapy. That is certainly my opinion.

    However, the issue becomes much more convoluted when some of the more recent political issues are thrown into the mix. Given the in-roads that PTs have had at the state level regarding physician-owned PT practices (POPTs), such as South Carolina and California, some MD/DOs/DPMs would like to be able to refer their patients to a rehab center that they own that is staffed with ATCs. This benefits them in several ways in that the average salary for an ATC is less than that of a PT so they have smaller costs associated with salary, and they continue to recieve a portion of the money that the rehab center makes.

    ATCs seem like they are pushing this bill in an attempt to gain traction in the rehabilitation market, correctly realizing that being toitally left out of the Medicare picture severely limits their utilization in the typical outpatient rehab clinic. I can't say that I blame them, but I think they may be being a bit cavalier with their descrption of "athlete."

    I will write more later when time permits....patient coming in a few minutes.
     
  13. sierra54

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    This is from the Board of Certification for athletic trainers. The Role Delineation/Practice Analysis identifies entry-level skills for ATC's.

    http://www.bocatc.org/index.php?option=com_content&task=view&id=109&Itemid=117

    http://www.bocatc.org/images/stories/resources/rdpa6_content_outline.pdf

    All educational programs must address these competencies within their curriculums.
     
  14. Sheldon

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    Direct acces is not self-referral or referral for profit. If a patient comes to a PT clinic via direct access, he or she may have been referred to said clinic from a friend, looked up that clinic, or had a previous experience at the clinic. The point with direct access is that the patient gets to choose, and that a script from a physician is not required (PT automony). The patient technically referred themselves to the clinic. The physical therapist does the evaluation and then decides if the patient is appropriate for additional physical therapy services, needs to see a physician, or both.
    Physician-owned physical therapy services is another story. The physician is getting reimbursed for his or her services in the clinic, and then, should the physician referral to a PT practice where he or she benefits monetarily, is then benefiting from physical therapy services. Think of it as double-dipping. It's not right. How would physicians feel if a PT grouped owned a physician practice?
     
  15. atstudent

    atstudent Certified Athletic Traine
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    What about if the physician owned the building and a PT company rented space from the physician? Would that also be a conflict of interest you think?

    Or I know one place where the PT clinic and the physician's office don't only share the same building, they share the same waiting room! Although they are separate companies..
     
  16. atstudent

    atstudent Certified Athletic Traine
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    I would agree that some athletic trainers have become a bit cavalier with the term. i don't agree with them doing so. I want to treat athletes and feel like I am qualified to treat a runner whether he is 15 or 45 I can treat him for his Achilles Tendinitis.
     
  17. jesspt

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    Neither of these seem like a conflict of interest situation to me, provided that the rent is at market value.
     
  18. fozzy40

    fozzy40 Senior Member
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    Agree:thumbup:
     
  19. jesspt

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    I would agree with you. Heck, CMS might agree with you, but it's not relevant to the bill you originally posted on, as the NATA wants ATCs to be able to provide service to the Medicare population.

    I think the primary issues between PTs and ATC regarding access to the Medicare population is whether the ATC is adequately prepared to recognize when a patient needs to be referred back to their physician, and if their didactic preparation is adequate to allow for them to understand the effects of aging and how to modify their rehabilitation respective to that. I myself have little knowledge of the ATC curriculum and will need to look at the links you posted previously.
     
  20. atstudent

    atstudent Certified Athletic Traine
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    We spent a great deal of time talking about referring patients to other healthcare providers. We are trained to recognize numerous "general medical" conditions and some we are able to treat whereas others are referred on.

    I'm sure there are plenty of athletic trainers who think they can adequately care for a 65+ patient and to a large extent I would disagree with that notion. I have no interest in doing so myself.

    But Medicare and the CMS holds the strings to a lot of insurance companies. An insurance company is often going to follow what CMS says. So if the CMS says we're qualified, it's more likely that a 3rd party insurance is going to recognize us and reimburse us. I believe that is a large reasoning for this legislation.

    I have mixed views on this whole idea. On one hand, I believe athletic trainers need to be in high schools and stay out of other settings that the profession has moved into. On the other hand, I work in a clinical outreach setting and it's frustrating to me that I am "qualified" to treat a high school kid's ankle injury when I am at the school, but the moment I step into the rehab clinic I am no longer "qualified" and that treatment has to be turned over to a PT.
     
  21. johncronejr

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    Think about that.....If the physician owns the building and leases office space to a PT, then there is a set monthly lease amount. No matter how many referrals the MD kicks the way of his tenant, the monthly lease payment remains the same. I would say this is not a conflict of interest, some may say it is, but the idea of conflict of interest is that the arrangement can be abused for profit,meaning that some patients may be referred who don't actually need the physical therapy.

    As far as a PT clinic and an MD sharing a waiting room, all I can say is "and.....?"
     

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